Rheumatoid arthritis in my lungs
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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From the Arthritis Foundation and the American College of Rheumatology
Rheumatoid lung disease is a relatively common complication of rheumatoid arthritis. Of the estimated 2.1 million Americans who have rheumatoid arthritis, nearly half may have some abnormal lung function.
Up to one-fourth or about 500,000 people develop rheumatoid lung disease.
Symptoms associated with rheumatoid lung disease which occur in addition to arthritic symptoms of joint pain, joint swelling, joint stiffness, and nodules include:
-Shortness of breath
-Crackle sounds when listening to lungs with stethoscope (but decreased breath sounds or normal breath sounds are also possible)
Chest x-rays, CT scan of the chest, echocardiogram, thoracentesis, and bronchoscopy are procedures used to help diagnose rheumatoid lung disease. Currently there are no effective treatments for rheumatoid lung disease. Corticosteroids, immunosuppressive therapies, including disease-modifying anti-rheumatic drugs and biologics, help treat the complications.
In rheumatoid lung disease, the air sacs or alveoli of the lungs and their supporting structures become scarred by inflammation, resulting in impaired lung function. The thoracic and pulmonary abnormalities associated with rheumatoid lung disease include:
-Bronchiolitis obliterans organizing pneumonia (BOOP)
The most common manifestation of pulmonary disease in rheumatoid arthritis (RA) is interstitial lung disease (ILD). Patients with severe rheumatoid arthritis or patients who smoke are more likely to develop RA-associated interstitial lung disease.
In addition, Some of the therapies used for rheumatoid arthritis have been associated with lung disease.
Gold salts may cause lung inflammation as can penicillamine which has been associated with bronchiolitis obliterans.
Methotrexate may cause pneumonitis- an acute inflammation of the lungs. The first symptom is often a cough.
Anti-TNF drugs have been associated with reactivation tuberculosis (particularly common with infliximab). Other lung diseases such as histoplasmosis and coccidiomycosis may also be reactivated.
Findings reported in January 2005 by Mayo Clinic researchers suggest that rheumatoid lung disease may be "fundamentally different from other forms of lung disease", and possibly should be treated differently. Through advancements in computer-assisted image analysis, it may be possible to diagnose rheumatoid lung disease earlier and treat it aggressively as a disease of the immune system.
The Mayo Clinic research revealed an abundance of T cells known as CD4 and CD3 cells in rheumatoid lung disease tissue samples. These findings may impact the development of new, more effective drugs to treat rheumatoid lung disease. Drugs designed to block T cell action may ultimately allow for treatment of rheumatoid lung disease in its early stages -- possibly even prolonging lives -- important because Mayo Clinic research indicated rheumatoid arthritis which spreads beyond the joints to the lungs is more likely to be fatal.
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Second Opinion Arthritis Treatment Kit
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